non-pitting edema and rating

Hi all!
I am a first semester nursing student and in my first clinical. From my understanding "non-pitting" edema was not rated. Is that correct? My instructor has taken points off twice for not rating my "non-pitting" edema. At first I thought she just didn't see the NON part, but when I mentioned it she said that there is 1-4 for non-pitting and 1-4 for pitting. No one I talk to seems to know what she is talking about. I thought the 1-4 stood for how much time it took for the pitting to go away after the skin was pressed on?? I just don't want to keep getting it wrong! Thanks much!!
Marisa

I have always described edema as either pitting or non-pitting, and used a numeric scale to describe the depth. The facility I presently work at uses the following numeric scale to describe the depth of the depression:

1+: 0 - 0.25 inch
2+: 0.25 - 0.5 inch
3+: 0.5 - 1 inch
4+: >1 inch

You might also review the facility's policies and procedures where you are doing clinicals as they might address this in either a documentation or assessment policy.

Dec 3, '10

I looked this up one time, don't remember the source, and it connected the rating to pitting edema, not non-pitting. I had been using depth of pitting prior. Can be confusing.

Dec 3, '10

Hey Marisa, I am no expert, I am a new grad RN. But, what I was taught is that only pitting edema is rated 1-4 based on depth of the indentation made in mm. So, +1 pitting would be 2mm indentation, +2 would be 4 mm indentation, +3 would be 6 mm indentation, and +4 would be 8 mm or more. As far as I know, non-pitting edema is not rated 1-4. Hope you find an answer to this from someone more experienced than I, otherwise, I would definitely discuss this further with your instructor! Best of luck to you.

Dec 3, '10

Hi Chare! So are you saying that non-pitting wouldn't be rated because it wouldn't have any depth? I wasn't sure what you meant. Thanks for your replies everyone!! You would think that something like rating edema would be more straight forward, wouldn't you :-)

Hi Chare! So are you saying that non-pitting wouldn't be rated because it wouldn't have any depth? I wasn't sure what you meant. Thanks for your replies everyone!! You would think that something like rating edema would be more straight forward, wouldn't you :-)

Although I can't speak for Chare, I'm pretty sure that IS what she means. Pitting edema is rated to establish the degree of the edema. 4+ Pitting edema, for instance indicates a far greater fluid overload than 1+ pitting and definitely non-pitting edema.

The 1-4 portion of the scale is ONLY for pitting edema. That would be like being asked to document the number of teeth after you already documented the baby as toothless...

As a matter of fact, documenting a pitting rating when you documented non-pitting would raise a red flag if the file ever went to court. It would display a lack of knowledge, either for the care of the patient as a whole, or at least for the charting system. Both will raise enough doubt in your credibility to become an issue.

I would directly address the issue with your instructor. I'm pretty sure Jarvis even states the exact same rationale for the pitting edema ratings.

With Love,
Dane

Dec 4, '10

Ourcharting system has a spot where you check off whether it is pitting or not but also a 1-4 rating for how much edema there is.

Dec 4, '10

Your instructor is crazy. As the others stated, pitting edema is rated by how many millimeters of depression the edema holds after you press it. Non-pitting edema could only, by definition, be rated a zero.

Dec 4, '10

Thanks for the replies! That is what I thought! I was so shocked when she said to rate the non-pitting edema. So what would you all do about it? I don't want to keep getting marked off for it, and I don't want to just make something up to make her happy either. I am not sure what I could say to her that wouldn't offend her. She may be the type that isn't that receptive to a student insinuating that she is wrong. Any advice??

Dec 4, '10

Hi Dane,
I just saw your suggestion about the Jarvis. I did look that up and you are correct. I guess I might just ask her about the edema under the pretense that I am not sure how the 1-4 rating system works for the non-pitting and could she explain it so I do it right on this next assignment. Then I will probably bring up the fact that Jarvis says rating is specifically for non-pitting. Hopefully she will be willing to look into it and find that the rating system is just for pitting as well. thanks again for the advice!
Marisa

Dec 4, '10

Our ICU uses a flowsheet for charting and provides a rating system for non-pitting as well as pitting edema. Next to each rating it provides guidelines to help you determine which rating is most appropriate (pitting is rated by depth/time while non-pitting is rated by area). I'm not familiar with any standard guidelines for rating non-pitting edema but you might check with the unit/facility and see if there is something they use.

Dec 4, '10

Marisa, I had a question about this just last month, where I work someone was grading NON pitting edema, I was confused! I went to my supervisor , just to see if there was something I was missing, she said No , the grade 1-4 is for PITTING edema, I even looked this up on the internet too, nothing for NON pitting edema.

Dec 4, '10

Non-pitting edema has no rating to it. Although, it seems to me that there are sooo many nurses our there that think it can be rated. I've had patients that I'm charting on, and see a previous nurse charted "2+ non-pitting edema." Your instructor has it wrong.

If you can find it explained well in a book, I'd show it to her. Otherwise, just rate your non-pitting edema for her so you can get your grade. lol